New rules could require hospitals to overhaul disaster preparedness

National rules would impose more coordinated, defined response to disasters

HHS officials are calling for sweeping new requirements for the nation's health care providers that would ensure that all facilities—from large hospitals to home health agencies—are prepared to act in the event of a disaster, the New York Times' Sheri Fink reports.

The proposed rule applies to more than 68,000 institutions, including major hospital chains, nursing homes, home health centers, rural health clinics, organ transplant agencies, ambulatory surgery centers, psychiatric centers, and kidney dialysis services. Altogether, they serve an estimated nine million fee-for-service patients each month, as well as Medicare Advantage and Medicaid beneficiaries.

The regulations would impose different requirements on the 17 types of health care providers affected. For example, the proposal calls on:

  • Hospitals, nursing facilities, and group homes to maintain emergency lighting, fire safety systems, sewage and waste disposal, and keep temperatures in a safe range during power losses;
  • All inpatient facilities to implement a system to locate displaced patients, provide treatment at alternate care sites, and handle volunteers;
  • Transplant centers to identify alternate hospitals for patients awaiting organs;
  • Home health care agencies to help patients create personalized disaster plans;
  • Hospices and others treating frail, homebound patients to have tracking procedures in place;
  • Health care employees to conduct disaster drills and administrators to coordinate response plans with local business competitors.

The agency described emergency preparedness as an "urgent public health issue," and pointed to the severe disruptions in health care that occurred following Hurricane Sandy and Hurricane Katrina in 2005. "In New Orleans, it seems very likely that dozens of lives could have been saved by competent emergency planning and execution," the proposal states.

The chaotic medical evacuations that occurred during these storms is evidence of a pressing need for regulatory consistency among health care facilities, which are governed by a patchwork of federal, state, and local rules.

Federal officials say a broad, nationwide approach is needed to ensure that the health facilities band together during crises and that poorly prepared institutions do not create stress for others.

Critics question costs

Overall, the proposal would cost $225 million in the first year of implementation, and critics warned that the million-dollar price tag could be "draconian" for the nation's hospitals. In a member advisory, the American Hospital Association charged that federal officials "may have significantly underestimated the burden and cost associated with complying with this rule."

But Fink notes that the proposal, which officials have three years to finalize, estimates that the rules will cost an individual hospital only about $8,000 in the first year and about $1,262 annually for skilled nursing facilities.

The Greater New York Hospital Association's Susan Waltman argued that the rules would be "a resource-intensive process for many providers." For instance, upgrading emergency power systems to run air-conditioning that meets patient safety standards alone could cost anywhere from tens of thousands of dollars to millions of dollars, according to hospital engineers.

One of the most contested regulations involves the need for hospitals and nursing homes to test backup generators for extended periods on an annual basis, rather than every three years. The four-hour, full-load tests carry significant fuel and labor costs, and critics questioned whether more frequent testing would enhance system safety.

ProPublica: Why hospital generators sometimes fail

More action needed, others say

Other health care groups believe that the proposal should go further, regardless of the price tag. For example, the American Academy of Pediatrics argues that hospitals should not only be required to keep emergency stocks of foods, water, and medical supplies on hand for patients and staff, but also for visiting family members and volunteers.

NYU Langone Medical Center, which lost power during Hurricane Sandy, is already moving forward on emergency preparedness upgrades. Although the hospital lost billions in revenue from the storm, it is spending millions on a new project that involves upgrading critical systems from low-level floors and building a cogeneration plan that operates independently of New York City's utility grid. 

The project is expected to provide a more reliable source of power and climate control during prolonged city shutdowns than diesel generator systems, as well as improve daily operating costs, says Paul Schwabacher, who oversees facilities management at Langone. He says, "For hospitals, cooling and heating systems are as critical for life support as maintaining power" (Fink, Times, 3/11). 

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